Faculty Collaboration Database

Pediatric otogenic lateral sinus thrombosis: role of anticoagulation and surgery. Int J Pediatr Otorhinolaryngol 2012 Mar;76(3):428-32

Date

01/27/2012

Pubmed ID

22277267

DOI

10.1016/j.ijporl.2011.12.025

Scopus ID

2-s2.0-84856777870 (requires institutional sign-in at Scopus site)   41 Citations

Abstract

OBJECTIVES: 1. To discuss the presentation, work up, and treatment of a series pediatric patients presenting with acute otogenic lateral sinus thrombosis (OLST). 2. To review the literature in discussing surgical treatment and the role of anticoagulation for sinus thrombosis from complicated otomastoiditis.

STUDY DESIGN: Retrospective case series.

METHODS: Retrospective case series of seven patients with otomastoidits and lateral sinus thrombosis were included in the study. Type of anticoagulation used and both clinical and radiographic outcomes were compared. Pediatric literature review was conducted using PubMed search terms "thrombosis and otitis media and anticoagulation" limited to English.

RESULTS: Seven patients presented with acute otomastoiditis with sigmoid sinus thrombosis. Six patients were treated with anticoagulation for 1.5-12 months. Six patients underwent myringotomy with tube and 4 patients underwent cortical mastoidectomy without thrombectomy. Six patients had resolution of thrombosis by imaging in less than 6 months. Literature review of 19 pts with OLST showed that 95% had mastoidectomy and 84% had myrigotomy with tube. All 19 patients received anticoagulation. Sixteen patients had complete clinical recovery with recanalization or resolution of clot in 3 patients.

CONCLUSIONS: The treatment of OLST is controversial. Most (23/26) patients had complete clinical recovery despite clot resolution in 9 of the 26 patients. Four patients had bleeding complication with anticoagulation. This series and literature review highlights the controversy of surgery and use of anticoagulation in the treatment of OLST and the need for further investigation.

Author List

Sitton MS, Chun R

Author

Robert H. Chun MD Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Anticoagulants
Child
Child, Preschool
Female
Humans
Lateral Sinus Thrombosis
Male
Mastoiditis
Middle Ear Ventilation
Osteotomy
Otitis Media
Retrospective Studies
Treatment Outcome